Healthcare Provider Details

I. General information

NPI: 1457047482
Provider Name (Legal Business Name): COMMONWEALTH ORAL & MAXILLOFACIAL SURGERY OF ARLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WATER ST STE 3B
ARLINGTON MA
02476-4812
US

IV. Provider business mailing address

11 WATER ST STE 3B
ARLINGTON MA
02476-4812
US

V. Phone/Fax

Practice location:
  • Phone: 781-202-6292
  • Fax:
Mailing address:
  • Phone: 781-202-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TOBY J FELDMAN
Title or Position: OWNER
Credential: DDS
Phone: 781-202-6292